[Congressional Record Volume 144, Number 141 (Friday, October 9, 1998)]
[Senate]
[Pages S12165-S12167]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. TORRICELLI. (for himself and Mr. Lautenberg):
  S. 2598. A bill to require proof of screening for lead poisoning and 
to ensure that children at highest risk are identified and treated; to 
the Committee on Finance.


     children's lead prevention and inclusive treatment act of 1998

 Mr. TORRICELLI. Mr. President, today with my colleague from 
New Jersey, Senator Lautenberg, I introduce the ``Children's Lead 
Prevention and Inclusive Treatment Act of 1998.'' For almost thirty 
years Congress has focused attention on lead-related issues. In 1971 we 
first passed the Lead-based Paint Poisoning Prevention Act, and much 
has been done since that time to identify children with elevated lead 
levels, to educate parents on the dangers of lead, and to devise means 
of removing or controlling lead in homes. Over the last 20 years, the 
removal of lead from gasoline, food canning, children's toys, and other 
sources has seen a reduction in national population blood lead levels 
by over 80 percent.
  Yet recent studies indicate that we are still not doing enough. While 
national lead levels have dropped over 80 percent, the numbers for 
Medicaid children, and poor children overall, are nothing short of 
disgraceful. Since 1992 the Health Care Financing Administration, at 
the behest of Congress, has required that Medicaid children be screened 
for elevated blood-lead levels at least twice before they reach the age 
of 2. But the Centers for Disease Control and Prevention estimates that 
nationally, 890,000 children between the ages of one and five have 
elevated blood lead levels and have never been tested.
  Even worse, Mr. President, in a Report to Congress earlier this year, 
the General Accounting Office reported that almost 79 percent of 
Medicaid children under two years of age have never been screened! This 
means that as many as 206,000 Medicaid children between the ages of 1 
and 2 have not been screened. Considering that in 1991 the U.S. Public 
Health Service called for a society-wide effort to eliminate childhood 
lead poisoning by the year 2011, it is quite apparent that we are not 
making much progress in reaching that goal.
  A subsequent GAO report further identified poor and minority children 
as being at greatest risk of lead poisoning. GAO reported that the 
prevalence of elevated blood lead levels in Hispanic children aged 1 
through 5 was more than twice that of white children, and for African-
American children it was more than five times that of white children. 
Additionally, children in families below 130 percent of the Federal 
poverty level had a higher prevalence of elevated blood lead levels 
than those children above the Federal poverty level. Yet all these 
children continue to be the very ones falling through the cracks!
  That is why, Mr. President, I am introducing this legislation. The 
Children's Lead PAINT Act promises to be a three-pronged attack on the 
lead-screening system. First, it will create a ``safety net'' through 
WIC and Early Start to ensure that high-risk children are screened. A 
parent enrolling their child in either of these programs must provide 
proof of screening, within 180 days of enrollment. If a child hasn't 
been screened, a parent can request WIC or Early Start to perform the 
test themselves. Additionally, if WIC or Early Start performs the test, 
Medicaid will be authorized to reimburse the program.
  Second, we will be putting teeth into the State's screening 
obligation, by setting a Minimum number of Screenings a State must 
perform, or having it face a penalty for failure. Beginning in Fiscal 
Year 2000, States will be required to screen at least 50 percent of 
Medicaid children under age 2. This will increase 10 percent each year 
until it hits 90 percent, where it must remain. If States fail to meet 
these targets, they stand to lose one percent of their Medicaid funds.
  Finally, Mr. President, we will require any Health Care Provider that 
signs a State Medicaid contract to agree in that contract to comply 
with the screening requirements, and to provide follow-up services to 
children who test positive. Although States have been required to 
perform these screenings, they are not a mandatory requirement of 
Medicaid health care contracts. Thus, there is no statutory obligation 
on the part of physicians to perform the tests. This will ensure that 
doctors perform the tests and that if a child does test positive that 
an environmental assessment will be done at their home and that follow-
up testing and evaluations will be conducted.
  I am especially pleased that I have been joined in this fight by two 
highly regarded national advocacy groups. The Alliance to End Childhood 
Lead Poisoning, a non-profit public interest organization exclusively 
dedicated to the elimination of childhood lead poisoning, has publicly 
endorsed the Lead PAINT Act. Similarly, the Coalition to End Childhood 
Lead Poisoning, a non-profit parents and victims organization dedicated 
to educating the public on the dangers of lead poisoning and as well as 
to eradicating this disease, has also publicly endorsed this 
legislation.
  Mr. President, although we have made great progress in lead poison 
prevention techniques, first, by banning lead-based paint in homes and 
more recently by strengthening our home testing system, the GAO report 
makes it very clear that we are failing to identify those children with 
lead already in their bodies. It is time we demand accountability. Our 
children deserve no less.
  I look forward to working with my colleagues on this legislation and 
this issue. I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2598

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Children's Lead Prevention 
     and Inclusive Treatment Act of 1998'' or the ``Children's 
     Lead PAInT Act''.

     SEC. 2. FINDINGS AND PURPOSES.

       (a) Findings.--Congress finds that--
       (1) lead poisoning remains a serious environmental risk, 
     especially to the health of young children;
       (2) childhood lead poisoning can cause reductions in IQ, 
     attention span, reading, and learning disabilities, and other 
     growth and behavior problems;
       (3) children under the age of 6 are at the greatest risk 
     because of the sensitivity of their developing brains and 
     nervous systems;
       (4) poor children and minority children are at 
     substantially higher risk of lead poisoning;
       (5) it is estimated that more than 500,000 children 
     enrolled in medicaid have harmful levels of lead in their 
     blood;
       (6) children enrolled in medicaid represent 60 percent of 
     the 890,000 children in the United States with elevated blood 
     lead levels;
       (7) although the Health Care Financing Administration has 
     required mandatory blood lead screenings for children 
     enrolled in medicaid who are not less than 1 nor more than 5 
     years of age, approximately two-thirds of children enrolled 
     in medicaid have not been screened or treated;

[[Page S12166]]

       (8) the Health Care Financing Administration mandatory 
     screening policy has not been effective, or sufficient, to 
     properly identify and screen children enrolled in medicaid 
     who are at risk;
       (9) uniform lead screening requirements do not exist for 
     children not enrolled in medicaid; and
       (10) adequate treatment services are not uniformly 
     available for children with elevated blood lead levels.
       (b) Purpose.--The purpose of this Act is to create a lead 
     screening safety net that will, through medicaid and other 
     entitlement programs, ensure that low-income children at the 
     highest risk of lead poisoning receive blood lead screenings 
     and appropriate followup care.

     SEC. 3. INCREASED LEAD POISONING SCREENINGS AND TREATMENTS 
                   UNDER THE MEDICAID PROGRAM.

       (a) Penalty for Insufficient Increases in Lead Poisoning 
     Screenings.--
       (1) Performance improvement.--Section 1903 of the Social 
     Security Act (42 U.S.C. 1396b) is amended by adding at the 
     end the following:
       ``(x) Performance Improvement.--
       ``(1) In general.--Notwithstanding section 1905(b), 
     beginning with fiscal year 2000 and for each fiscal year 
     thereafter, with respect to any State that fails to meet 
     minimum blood lead screening rates stated in paragraph (2), 
     the Federal medical assistance percentage determined under 
     section 1905(b) for the State for the fiscal year shall be 
     reduced by 1 percentage point, but only with respect to--
       ``(A) items and services furnished under a State plan under 
     this title during that fiscal year;
       ``(B) payments made on a capitation or other risk-basis 
     under a State plan under this title for coverage occurring 
     during that fiscal year; and
       ``(C) payments under a State plan under this title that are 
     attributable to DSH allotments for the State determined under 
     section 1923(f) for that fiscal year.
       ``(2) Minimum blood lead screening rates.--The minimum 
     acceptable percentages of 2-year-old medicaid-enrolled 
     children who have received at least 1 blood lead screening 
     test are--
       ``(A) 50 percent in fiscal year 2000;
       ``(B) 60 percent in fiscal year 2001;
       ``(C) 70 percent in fiscal year 2002;
       ``(D) 80 percent in fiscal year 2003; and
       ``(E) 90 percent in each fiscal year after fiscal year 
     2003.
       ``(3) Modification or waiver.--The Secretary may modify or 
     waive the application of paragraph (1) in the case of a State 
     that the Secretary determines has performed during a fiscal 
     year such a significant number of lead blood level 
     assessments that the State reasonably cannot be expected to 
     achieve the minimum blood lead screening rates established by 
     paragraph (2).''.
       (2) Reporting requirement.--Section 1902(a)(43)(D) of the 
     Social Security Act (42 U.S.C. 1396a(a)(43)(D)) is amended--
       (A) in clause (iii), by striking ``and'' at the end;
       (B) in clause (iv), by striking the semicolon and inserting 
     ``, and''; and
       (C) by adding at the end the following:
       ``(v) the number of children who are not more than 2 years 
     of age and enrolled in the medicaid program and the number 
     and results of lead blood level assessments performed by the 
     State, along with demographic and identifying information 
     that is consistent with the recommendations of the Centers 
     for Disease Control and Prevention with respect to lead 
     surveillance;''.
       (b) Mandatory Screening Requirements.--Section 1902(a) of 
     the Social Security Act (42 U.S.C. 1396a(a)) is amended--
       (1) in paragraph (65), by striking the period and inserting 
     ``; and''; and
       (2) by adding at the end the following:
       ``(66) provide that each contract entered into between the 
     State and an entity (including a health insuring organization 
     and a medicaid managed care organization) that is responsible 
     for the provision (directly or through arrangements with 
     providers of services) of medical assistance under the State 
     plan shall provide for--
       ``(A) compliance with mandatory screening requirements for 
     lead blood level assessments (as appropriate for age and risk 
     factors) that are commensurate with guidelines and mandates 
     issued by the Secretary through the Administrator of the 
     Health Care Financing Administration; and
       ``(B) coverage of appropriate qualified lead treatment 
     services, as prescribed by the Centers for Disease Control 
     and Prevention guidelines, for children with elevated levels 
     of lead in their blood.''.
       (c) Reimbursement for Treatment of Children with Elevated 
     Blood Lead Levels.--Section 1905 of the Social Security Act 
     (42 U.S.C. 1396d) is amended--
       (1) in subsection (a)--
       (A) in paragraph (26), by striking ``and'' at the end;
       (B) by redesignating paragraph (27) as paragraph (28); and
       (C) by inserting after paragraph (26) the following:
       ``(27) qualified lead treatment services (as defined in 
     subsection (v);''; and
       (2) by adding at the end the following:
       ``(v)(1) The term `qualified lead treatment services' means 
     all appropriate and medically necessary services that are 
     provided by a qualified provider, as determined by the State, 
     to treat a child described in paragraph (2), including--
       ``(A) environmental investigations to determine the source 
     of a child's lead exposure, including the costs of qualified 
     and trained professionals (including health professionals and 
     lead professionals certified by the State or the 
     Environmental Protection Agency) to conduct such 
     investigations and the costs of laboratory testing of 
     substances suspected of being significant pathways for lead 
     exposure (such as lead dust, paint chips, bare soil, and 
     water);
       ``(B) professional case management services to coordinate 
     access to such services; and
       ``(C) emergency measures to reduce or eliminate lead 
     hazards to a child, if required (as recommended by the 
     Centers for Disease Control and Prevention).
       ``(2) For purposes of paragraph (1), a child described in 
     this paragraph is a child who--
       ``(A) has attained 6 months of age but has not attained 73 
     months of age; and
       ``(B) has been identified as having a blood lead level that 
     equals or exceeds 20 micrograms per deciliter (or 
     persistently equals or exceeds 15 micrograms per 
     deciliter).''.
       (d) Effective Date.--
       (1) In general.--The amendments made by this section apply 
     on and after October 1, 1998.
       (2) Extension of effective date for state law amendment.--
     In the case of a State plan under title XIX of the Social 
     Security Act which the Secretary of Health and Human Services 
     determines requires State legislation in order for the plan 
     to meet the additional requirements imposed by the amendments 
     made by this section, the State plan shall not be regarded as 
     failing to comply with the requirements of this section 
     solely on the basis of its failure to meet these additional 
     requirements before the first day of the first calendar 
     quarter beginning after the close of the first regular 
     session of the State legislature that begins after the date 
     of the enactment of this Act. For purposes of the previous 
     sentence, in the case of a State that has a 2-year 
     legislative session, each year of the session is considered 
     to be a separate regular session of the State legislature.

     SEC. 4. LEAD POISONING SCREENING FOR SPECIAL SUPPLEMENTAL 
                   NUTRITION PROGRAM FOR WOMEN, INFANTS, AND 
                   CHILDREN.

       Section 17(d) of the Child Nutrition Act of 1966 (42 U.S.C. 
     1786(d)) is amended by adding at the end the following:
       ``(4) Lead poisoning screening.--
       ``(A) In general.--Subject to subparagraph (B), for an 
     infant or child to be eligible to participate in the program 
     under this section, a member of the family of the infant or 
     child shall provide proof to the State agency, not later than 
     180 days after enrollment of the infant or child in the 
     program and periodically thereafter (as determined by the 
     State agency), that the infant or child has received a blood 
     lead test for lead poisoning using an assessment that is 
     appropriate for age and risk factors.
       ``(B) Waivers.--A State agency or local agency may waive 
     the requirement of subparagraph (A) with respect to an infant 
     or child if the State agency or local agency determines 
     that--
       ``(i) the area in which the infant or child resides does 
     not pose a risk of lead poisoning; or
       ``(ii) the requirement would be contrary to the religious 
     beliefs or moral convictions of the family of the infant or 
     child.
       ``(C) Screenings by state agencies.--
       ``(i) In general.--On the request of a member of a family 
     of an infant or child who has not been screened for lead 
     poisoning and who seeks to participate in the program, at no 
     charge to the family, a State agency shall perform a blood 
     lead test on the infant or child that is appropriate for age 
     and risk factors.
       ``(ii) Reimbursement.--On the request of a State agency 
     that screens for lead poisoning under clause (i) an infant or 
     child that is receiving medical assistance under a State plan 
     under title XIX of the Social Security Act (42 U.S.C. 1396 et 
     seq.), the Secretary of Health and Human Services shall 
     reimburse the State agency, from funds that are made 
     available under that title, for the cost of the screening 
     (including the cost of purchasing portable blood lead 
     analyzer instruments approved for sale by the Food and Drug 
     Administration and providing screening with the use of such 
     instruments through laboratories certified under section 353 
     of the Public Health Service Act (42 U.S.C. 263a)).''.

     SEC. 5. LEAD POISONING SCREENING FOR EARLY HEAD START 
                   PROGRAMS.

       Section 645A of the Head Start Act (42 U.S.C 9840a) is 
     amended--
       (1) in subsection (c)(2), by inserting before the semicolon 
     the following: ``, if the families comply with subsection 
     (i)''; and
       (2) by adding at the end the following:
       ``(i) Lead Poisoning Screening.--
       ``(1) In general.--Subject to paragraph (2), for a child to 
     be eligible to participate in a program described in 
     subsection (a)(1), a member of the family of the child shall 
     provide proof to the entity carrying out the program, not 
     later than 180 days after enrollment of the child in the 
     program and periodically thereafter (as determined by the 
     entity), that the child has received a blood lead test for 
     lead poisoning using an assessment that is appropriate for 
     age and risk factors.

[[Page S12167]]

       ``(2) Waivers.--The entity may waive the requirement of 
     paragraph (1) with respect to a child if the entity 
     determines that--
       ``(A) the area in which the child resides does not pose a 
     risk of lead poisoning; or
       ``(B) the requirement would be contrary to the religious 
     beliefs or moral convictions of the family of the child.
       ``(3) Screenings by entities.--
       ``(A) In general.--On the request of a member of a family 
     of a child who has not been screened for lead poisoning and 
     who seeks to participate in the program, at no charge to the 
     family, the entity shall perform a blood lead test on the 
     child that is appropriate for age and risk factors.
       ``(B) Reimbursement.--On the request of an entity that 
     screens for lead poisoning under subparagraph (A) a child 
     that is receiving medical assistance under a State plan under 
     title XIX of the Social Security Act (42 U.S.C. 1396 et 
     seq.), the Secretary shall reimburse the entity, from funds 
     that are made available under that title, for the cost of the 
     screening (including the cost of purchasing portable blood 
     lead analyzer instruments approved for sale by the Food and 
     Drug Administration and providing screening with the use of 
     such instruments through laboratories certified under section 
     353 of the Public Health Service Act (42 U.S.C. 
     263a)).''.
                                 ______